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As metodologias ativas geram estresse na medida em que o estudante é responsável pelo gerenciamento do próprio aprendizado. Na aprendizagem centrada no estudante, o ambiente das discussões ocorre, geralmente, em pequenos grupos em quase todos os cenários. O aluno vivencia tanto suas emoções quanto as de seus colegas. Os aspectos de sua personalidade, suas fragilidades, seu desempenho nos estudos sua capacidade de se adaptar ao grupo podem gerar conflitos internos. A ansiedade causada por estes sentimentos pode ser considerada, por si só, um estímulo estressor e na sociedade moderna vem se tornando algo comum, devido ao estresse e às exigências que o cotidiano traz. O método de ensino "Aprendizagem Baseada em Problemas" (PBL) na formação acadêmica médica acaba sendo mais um fator, que pode causar a ansiedade. Este estudo teve como objetivo avaliar a percepção dos estudantes de Medicina quanto ao processo de aprendizagem e ansiedade na metodologia de ensino PBL. Os resultados obtidos com base em um questionário modificado, após assinatura do termo de consentimento livre e esclarecido, sugerem que a maioria dos estudantes de medicina de Campo Grande - MS, 64,7% (223) apresenta níveis de ansiedade considerados leve, moderado ou grave. O nível de ansiedade foi baseado na Escala de Avaliação da Ansiedade de Hamilton.Palavras-chave: Ansiedade. Acadêmicos de Medicina. Aprendizagem Baseada em Problemas. PBL.AbstractActive methodologies generate stress because the students are responsible to manage their learning. In student-centered learning, the discussion environment usually occurs in small groups in almost all settings. The students could participate in own experiences and their colleagues. Students' personality aspects, weaknesses, performance in their ability to adapt to the group can generate internal conflicts. Anxiety caused by these feelings can be considered a stressful stimulus and in the modern society it has become common, due to the stress and the daily life's demands. The "Problem-Based Learning" (PBL) teaching method in medical academic could be another factor that can cause anxiety. This study aimed to evaluate the learning and anxiety caused by the PBL teaching methodology. The results obtained based on a modified questionnaire, after signing the informed consent, suggest that most medical students in Campo Grande-MS, 64.7% (223) presented anxiety levels considered mild, moderate or severe. Anxiety levels was based on the Hamilton Anxiety Assessment Scale. Keywords: Anxiety. Medical Students. Problem-Based Learning. PBL

AbstractIntroduction: Expanding and sustaining antiretroviral therapy (ART) coverage may require simplified HIV service delivery strategies that concomitantly reduce the burden of care on the health system and patients while ensuring optimal outcomes. We conducted a systematic review to assess the impact of reduced frequency of clinic visits and drug dispensing on patient outcomes.Methods: As part of the development process of the World Health Organization antiretroviral (ARV) guidelines, we systematically searched medical literature databases for publications up to 30 August 2016. Information was extracted on trial characteristics, patient characteristics and the following outcomes: mortality, morbidity, treatment adherence, retention, patient and provider acceptability, cost and patients exiting the programme. When feasible, conventional pairwise meta‐analyses were conducted.Results and discussion: Of 6443 identified citations, 21 papers, pertaining to 16 studies, were included in this review, with 11 studies contributing to analyses. Although analyses were feasible, they were limited by the sparse evidence base, despite the importance of the research area, and relatively low quality. Comparative analyses of eight studies reporting on frequency of clinic visits showed that less frequent clinic visits led to higher odds of being retained in care (odds ratio [OR]: 1.90; 95% CI: 1.21–2.99). No differences were found with respect to viral failure, morbidity or mortality; however, most estimates were favourable to reduced clinic visits. Reduced frequency of ARVs pick‐ups showed a trend towards better retention (OR: 1.93; 95% CI: 0.62–6.04). Strategies using community support tended to have better outcomes; however, their implementation varied, particularly by location. External validity may be questionable.Conclusions: Our systematic review suggests that reduction of clinical visits (and likely ARVs pick‐ups) may improve clinical outcomes, and that they are a viable option to relieve health systems and reduce burden of care for PLHIV. Strategies aimed at reducing clinic visits or drug refill services should focus on stable patients who are virally suppressed, tolerant to their drug regimen and fully adherent. These strategies may be critical to the current changes taking place in HIV treatment policy; thus, due to the data limitations, further high quality research is needed to inform policy and programmatic interventions.

<p class="Pa5"><strong>Objectives: </strong>To determine whether patients who are English proficient become aware of e-cigarettes through different marketing tac­tics and have dissimilar patterns of use than patients who are non-English speaking.</p><p class="Pa5"><strong>Design: </strong>This was a cross-sectional study surveying adult English- and Spanish-speak­ing patients. ANOVA and chi-squared tests were used to examine differences between groups.</p><p class="Pa5"><strong>Setting: </strong>A large public, safety-net hospital in Los Angeles County, California.</p><p class="Pa5"><strong>Results: </strong>Respondents (N=1899) were predominately Hispanic (78%), foreign-born (68%), and reported Spanish as a primary language (64%). Native English speakers re­ported the highest use of e-cigarettes (26%), followed by non-native (13%) and non- English speakers (2%) (P&lt;.001). In terms of marketing, native and non-native English speakers were more likely to have friends and family as sources of e-cigarette informa­tion (P&lt;.001). Native speakers were more likely to see advertisements for e-cigarettes on storefronts (P=.004) and on billboards (P&lt;.001). Non-English speakers were most likely to learn about e-cigarettes on the news (P&lt;.001) and in advertisements on the television and radio (P=.002). Differ­ences in reasons for use were not significant between the three groups.</p><p><strong>Conclusions: </strong>Native and non-native English speakers become aware of e-cigarettes through different mechanisms and use e-cigarettes at a significantly higher rate than non-English speakers. These results highlight an opportunity for public health programs to concentrate on specific channels of com­munication that introduce patient popula­tions to e-cigarettes to slow the spread of e-cigarette usage.</p><p><em>Ethn Dis. </em>2017;27(3):217- 222; doi:10.18865/ed.27.3.217</p>

Plumeria rubra L. é uma árvore rústica e pequena, com 4-8 metros de altura com folhas verdes grossas e suaves hastes, flores escuras e grandes que exalam uma fragrância agradável, similar aos de Jasminun sp. (Lamiales: Oleaceae). Esta planta é nativa da América Central, mas também foi introduzida na maioria das regiões tropicais e subtropicais do mundo em jardins, ruas e é usado para preparar colares e na medicina. O objetivo deste estudo foi identificar um Lepidoptera desfolhador de P. rubra na Universidade Federal de Viçosa, em Viçosa, Minas Gerais, Brasil. Este inseto foi identificado como Pseudosphinx tetrio (Linnaeus, 1771) (Lepidoptera: Saturniidae). Suas lagartas têm corpo negro com anéis amarelos, cobertos com cerdas torácicas e falsas pernas abdominais laranjas. O seu comprimento pode atingir 6 cm, possui um processo em forma de espinho preto e característica na parte de trás do oitavo tergo. Adultos são grandes e cinzas com listras transversais pretas e envergadura de 12.7 a 14,0 cm. As fêmeas, geralmente, maiores que os machos e de cor mais clara. Pseudosphinx tetrio devem ser incluídos em programas de monitoramento de pragas P. rubra.Palavras-chave: Apocynaceae. Herbívoro. Lepidoptera. Inseto UrbanoAbstractPlumeria rubra L. is a rustic and small tree with 4-8 meters high with thick and smooth stems, dark green leaves and large flowers exuding a pleasant fragrance, similar to those of Jasminun sp. (Lamiales: Oleaceae). This plant is native to Central America but it was also introduced to most tropical and subtropical regions of the world in gardens, streets and used to prepare necklaces and in Medicine. The objective of this study was to identify a Lepidoptera defoliator of P. rubra at the Federal University of Viçosa in Viçosa, Minas Gerais State, Brazil. This insect was identified as Pseudosphinx tetrio (Linnaeus, 1771) (Lepidoptera: Saturniidae). Its caterpillars have black body with yellow rings, covered with bristles thoracic, and abdominal prolegs are orange . Its length can reach 6 cm and it has a black and characteristic spiniform process on the back of the eighth tergo. Adult are large and gray with black transverse stripes and wingspan from12.7 to 14.0 cm. Females are usually larger than males and lighter in color. Pseudosphinx tetrio should be included in monitoring programs of P. rubra pests.Keywords: Apocynaceae. Herbivore. Lepidoptera. Urban Insect.

In a recently published IJHPR article, Cohen and Horev ask whether an individual who holds rightful governmental power is able to effectively "challenge the equilibrium" in ways that might "clash with the goals" of an influential group". This question is raised within the context of a shift in governmental policy that imposed the potential for cost management by HMOs acting as financial intermediaries for pediatric dental care in an effort to provide Israeli children better access to affordable dental care. The influential group referred to consists of Israel's private dentists and the individual seeking to challenge the equilibrium was an Israeli Minister of Health whom the authors consider to be a policy entrepreneur.The Israeli health care system is similar to that of the United States in that private benefit plans and self-pay financing dominate in dental care. This is in contrast to the substantial role of government in the financing and regulation of medical care in both countries (with Israel having universal coverage financed by government and the US having government financing the care of the elderly and the poor as well as providing subsidies through the tax system for the care of most other Americans).Efforts to expand governmental involvement in dental care in both countries have either been opposed by organized dentistry or have suffered from ineffective advocacy for increased public investment in dental care.In the U.S., philanthropic foundations have acted as or have supported health policy entrepreneurs. The recent movement to introduce the dental therapist, a type of allied dental professional trained to provide a narrow set of commonly-needed procedures, to the U.S. is discussed as an example of a successful challenge to the equilibrium by groups supported by these foundations. This is a somewhat different, and complementary, model of policy entrepreneurship from the individual policy entrepreneur highlighted in the Cohen-Horev paper.The political traction gained to change the equilibrium favored by organized dentistry - in both Israel and the U.S. - may reflect aspirations for care that is more accessible, patient-centered, accountable and equitable. Evolving aspirations may lead to policy changes to systematize the disparate, disaggregated dental care delivery system in both counties. A change in payment incentives to provide more value is being explored for medical care, and its expansion to dental care can be anticipated to be among the policies considered in the future.

<p style="margin: 0cm 0cm 0pt; line-height: 150%; text-indent: 0cm;"> </p><p class="PargrafoPablo">A recondução, que consiste no retorno do servidor público estável ao cargo anteriormente ocupado, em razão da reintegração do anterior ocupante ou de inabilitação em estágio probatório relativo a outro cargo, reveste-se de grande complexidade quando em sua aplicação prática nas repartições públicas. Por sua vez, a recondução de servidor federal após o exercício de cargo sob regime federal específico ou em outros entes federativos é, dentre os temas específicos no âmbito da recondução, um dos que mais controvérsia tem gerado ao longo do tempo, especialmente por trazer à tona o debate sobre a autonomia dos entes federativos sob a ótica da gestão de pessoas. O presente artigo pretende tratar tanto da evolução administrativa quanto da jurisprudencial que levaram à construção da interpretação atual sobre a recondução de servidor federal, quando esta se dá após o exercício de cargo sob regime federal específico ou cargo em outros entes federativos.</p><p class="PargrafoPablo"> </p><p class="PargrafoPablo">The reassignment, which consists in the return of the stable public servant to the position previously occupied, due to the reintegration of the previous occupant or disqualification probationary in relation to another position, is very complex when in its practical application in the public offices. Furthermore, the reassignment of a federal servant after the exercise of a position under a specific federal regime or in other federative units is, among the specific topics in the scope of reassignment, one of the most controversial ones, especially for bringing to the debate the autonomy of federative entities from the point of view of people management. The present article intends to deal with the administrative evolution and the jurisprudence that led to the construction of the current interpretation on the reassignment of federal servants, when this occurs after the exercise of a position under a specific federal regime or in other federative units.</p><p style="margin: 0cm 0cm 0pt; line-height: 150%; text-indent: 0cm;"><span style="font-family: Times New Roman; font-size: medium;"><br /></span></p>

Abstract
In all times, fruit trees for family use have been grown at Latvian farms. Yet these fruits obtained market value only after the land ownership reform in 19th century. This facilitated rapid area increase of different fruit crops, allowing supply with fruits not only the local market, but also for export to the largest cities of Russia. Especially fast development of fruit-growing was observed during the first independent republic (1919–1940). The demand for planting material increased, and plants were imported from Western Europe. Choice of unsuitable cultivars and rootstocks was the main reason of the massive orchard area loss during the following severe winters. After the Second World War, the Soviet powers supported only the establishment of large orchards for processing needs, 200-300 ha, which were unsuitable for the Latvian climate and terrain. At the same time, numbers of allotment gardens rapidly increased and part of their produce was sold also on the market. After regaining of independence and private property, interest in fresh fruit and berry production for market, as well as processing, renewed. It was hindered by lack of continuity in experience and knowledge. Diversity of terrain, soils and climate all demand considerate choice of suitable orchard location and cultivars. Direct use of foreign experience often led to failure. At present, development of the fruit industry is most of all hindered by lack of qualified specialists of different levels, which does not allow to establish an appropriate consulting system. Cooperation of growers for easier marketing also is developing too slowly. Insufficient economic and market research does not allow to balance the demand with increase of plantation area, especially for large-scale processing and export, so strategic guidance of the fruit industry is not possible. Development of fruit-growing is hindered also by a lack of continuous long-term support to horticultural science. As a result of research by the Institute of Horticulture: 1) new local breeding fruit crop cultivars were obtained and recommended for commercial orchards; variety testing including growing technologies was initiated in different regions of Latvia; 2) monitoring of harmful and favourable organisms was conducted in plantations, with development of a system for prognosis and control; and 3) research results were transferred to growers through practical recommendations, publications, seminars and demonstrations.

Wheat is one of the most cultivated cereals worldwide. Some wheat genotypes may be used for dual purposes that is, in the production of animal fodder and grains. The objective of this study was to compare the growth, partitioning of assimilates, and seed vigor expression of dual-purpose wheat cultivars originating from seeds produced by plants subjected to different cutting management systems. Dual-purpose wheat seeds in the vegetative period were used for this study; these were obtained from the cultivar BRS Umbu produced by plants subjected to different cutting management systems. The experimental design was completely randomized in a factorial scheme, with four replications. The treatments comprised a combination of four seed production systems (one, two, and three cuts) and eight planting seasons (10, 20, 30, 40, 50, 60, 70, and 80 days after emergence [DAE]). Total dry-mass, dry-mass production rate, relative growth rate, net assimilation rate, leaf area index, solar energy conversion efficiency, dry-mass partitioning, seedling emergence in the field, and emergence speed index were evaluated. Data regarding seedling emergence and emergence speed index were adjusted by orthogonal polynomials. Primary growth data were evaluated from the simple logistic equation. From 60 DAE, an inversion of the values of total dry-mass was observed, and the maximum values were observed in plants from seeds produced without cutting management. The highest dry-mass production rates were noted for plants produced by seeds of plants not subjected to cutting management. The highest relative growth rates were noted among plants originating from seeds produced by plants subjected to three- and two-cut treatments. The net assimilation rate was higher in plants originating from seeds produced from plants subjected to cutting management systems. The highest values of emergence were observed for seeds obtained from the three-cut treatment. Similarly, an increase in the values of emergence speed index was observed in seeds from plants subjected to one-cut treatment. Dual-purpose wheat cultivars originating from seeds produced in the absence of cutting management presented higher total dry-mass, dry-mass production rate, and relative growth rate. The net assimilation rate was higher in plants from seeds produced with cutting management systems. Plants produced from seeds subjected to the three-cut production management resulted in more vigorous seeds.

Background and Study Aims Bronchogenic carcinoma is the cancer that most commonly metastasizes to the brain. The standard treatment schedule for these patients is still unclear, although recommendation level 1 class I advocates for surgical resection together with postoperative whole-brain radiotherapy for patients with good Karnofsky performance status (KPS). We performed a study to identify prognostic factors for the long-term survival of patients with brain metastases from non–small cell lung cancer (NSCLC).
Patients This retrospective single-center study included 71 patients with brain metastases from NSCLC having undergone surgical metastasectomy between January 2002 and January 2015.
Results The average age was 58.8 years. A total of 85.9% of the lesions were located in the supratentorial region, 61.9% of the lesions were < 3 cm, and 80.3% of cases were solitary brain metastases. Complete resection was achieved in 90.1% of patients. Clinical debut with motor involvement was associated with higher rates of incomplete surgical resection. Patients with motor deficits had a worse preoperative KPS. The preoperative KPS was > 70 in 74.6% of patients, and the postoperative KPS was > 70 in 85.9% of patients. Overall, 84.5% of the brain surgeries had no complications. Brain metastases were diagnosed as a synchronous presentation in 64.7% of patients.The average survival after brain surgery was 20.38 months. The survival rate was 66.2% at 6 months, 45.1% at 12 months, 22.5% at 24 months, 14.1% at 36 months, and 8.5% at 48 months. Patients < 55 years of age showed a higher survival rate at 12 months and 48 months. Patients > 70 years of age showed a higher mortality rate at 6 months. Complete surgical brain metastasis resection was associated with an increased survival at 6 months, and patients undergoing primary lung surgery had better survival rates at 48 months. A preoperative KPS > 70% improved the prognosis of patients at 6 and 24 months. Surgical complications reduced survival at 6 and 12 months.
Conclusion Surgical resection may be beneficial for a given group of patients: a preoperative KPS > 70; age < 55 years, complete surgical brain metastasis resection, no surgical complications, patients with primary lung surgery, and complete radiotherapy treatment. We did not find any significant difference regarding further factors that probably affect survival rates such as size or number of metastases.

AbstractIntroduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low‐income countries, and especially in sub‐Saharan Africa where HIV prevalence and incidence are the highest. As they survive into adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa, highlighting the specific needs and challenges in these populations and settings, and the different models of care for transition.Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000 to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All qualitative and quantitative, experimental and observational studies including HIV‐infected patients aged 10–24 years with information on transition were eligible.Results: Few data on transition outcomes for HIV‐infected adolescents are available from Africa settings. Studies mainly from Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media. However, regardless of the model, services are increasingly overburdened and have insufficient human resources. Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older adults. There is a need to identify sub‐groups at higher risk of loss to follow‐up for targeted care and peer support.Expert commentary: Although the available HIV‐related data on adolescent transition outcomes are limited, there is evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.

ABSTRACT
ObjectivesCanada has established a pan-Canadian cohort with over 300,000 volunteer participants aged 35-69, to support research on cancer and chronic disease. A key feature of the cohort is that participants have consented to link their cohort data with administrative datasets. This prospective cohort, representing nearly 1 in 50 Canadians in this age range will be followed for multiple decades, building a platform that supports access to timely, high-quality, data related to cancer and other chronic diseases, which will enable researchers to answer complex system questions and achieve better health outcomes for Canadians.
ApproachA baseline "core" questionnaire was administered to participants capturing information on socio-demographics, economic characteristics, personal and familial history of diseases and lifestyle and health behaviours. A re-contact questionnaire is planned for 2016 to update baseline information and add depth to specific areas and capture changes over time. To realize the full potential for this cohort to support transformative research it is crucial to be able to link this data with other provincial datasets, such as cancer registries, hospital records and mortality data.
For the most part, health data in Canada resides under the purview of health providers and, or government custodians in each of the provinces and territories. As such, an innovative federated data linkage strategy is required to link cohort data with health administrative data in each regions, adhering to existing privacy and regulatory requirements, while providing central access for researchers.
ResultsTo date, 40% of all cohort participants have been linked with priority provincial administrative data. Each province has its own unique data linkage challenges, requiring unique customized solutions. By the end of 2017 we anticipate that the number of participants who will have had their data linked will increase to nearly 70%. The federated data linkage strategy and infrastructure offer an innovative approach that others can learn from; however to realize the full potential of the cohort and support transformative research partnerships and collaborations are required.
ConclusionEfforts to organize resources and establish systems for data linkage and optimize data sharing and utilization in Canada are underway and include discussions with the provincial privacy commissioners, national and provincial and territorial data custodians and other thought leaders in the field.

ABSTRACTObjectivesPrior use of antimicrobials, in particular broad-spectrum antimicrobials, is associated with the development of Clostridium difficile infection (CDI). Our previous work has demonstrated increased risk with cumulative exposure but there is limited evidence on specific patterns of cumulative antimicrobial prescribing prior to infection. Understanding this pattern will help inform antimicrobial stewardship. This study aims to investigate the prescribing patterns for CDI cases with more than 4 weeks cumulative antimicrobial exposure during the 6 months prior to their CDI date.ApproachWe linked three Scottish patient-level data sets: laboratory confirmed CDI (ECOSS), prescriptions for antimicrobials in primary care (PIS) and all hospital admissions (SMR01). From ECOSS all cases of CDI reported in the period August 2010 to July 2013 were identified. Each CDI case was linked to SMR01 to allocate case type (either hospital or community associated) and to PIS for previous antimicrobial prescriptions. Visual representation of temporal exposure indicating both duration and drug type of each antimicrobial dispensed during the 6 month period before the infection was produced to clearly understand the pattern of prescribing.ResultsIn the study period, there were a total of 1557 community acquired CDI cases without recent (prior 3 months) hospitalisation. Among them, 287 (18%) cases had more than 4 weeks prior cumulative antimicrobial exposure accumulating a total of 1311 dispensed prescriptions. Cases had an average 4 (Q1:3,Q3:6) prescriptions and 2 (Q1:2,Q3:3) different types of antimicrobials dispensed. The timeline plot shows that repeated short duration prescriptions contributed more to cumulative exposure than long duration prophylaxis. The most common antimicrobials prescribed were amoxicillin (38% of cases), trimethoprim (30%) and flucloxacillin (27%). The median duration per prescription for each of these was less than 2 weeks. The antimicrobials that had a median duration of around a month per prescription were oxytetracycline (3%) and clindamycin (6%).
ConclusionsThis study of a national linked patient level data set contained sufficient numbers of cases to enable investigation of the prescribing pattern in individuals with highest risk cumulative exposure. This study uses NHS Scotland's developing Infection Intelligence Platform which will place Scotland as a world leader in the use of health informatics to support infection control and antimicrobial stewardship.

ABSTRACTBackgroundLiving in a cold and/or damp house is known to increase the risk of morbidity, mortality and excess winter deaths. To reduce fuel poverty and its adverse health effects in Wales the Welsh Government developed programmes to improve the energy efficiency of homes. These included the Home Energy Efficiency Scheme (HEES) and subsequent Warm Homes NEST scheme. Both schemes supported those most likely to be affected by fuel poverty, including low income and vulnerable households from 2000 to 2015. The energy efficiency measures provided included insulation and heating upgrades, such as a more efficient boiler.
AimThe overall aim of the project is to evaluate the health impacts of Welsh Government funded schemes designed to improve the energy efficiency of the homes of low income households through the use of existing data (HEES and NEST linked to the routine health records held in the SAIL Databank at Swansea University).
MethodsA longitudinal dataset was created using the anonymised residential dwelling that has received home energy efficiency improvements linked to a summary of their health measures (hospital admissions, reason for the admission, GP prescriptions and clinical diagnoses).
Cohorts will be constructed of people who have already received the intervention to compare those who have not yet received the intervention but who went on to receive it two years later. We will use a stepped wedge design to construct an intervention and control cohort for each year of the study period. We will apply statistical techniques to conduct difference in difference (DID) estimations. This will allow us to compare any changes in the health of people before and after the intervention with any concurrent change in health in those who may require, but have yet to receive, the intervention.
ResultsWe anticipate concluding the analysis in June in order for the results to inform the redesign of the successor scheme to Warm Homes NEST, due to be consulted on during 2016 and in place from April 2017. Our results will compare specific interventions for their impacts on health. We will show whether particular population groups e.g. those suffering from particular health condition, gain particular benefit from interventions.
ConclusionOur findings have the potential to inform more effectively focussed home energy efficiency schemes in order to reduce the numbers of people living in fuel poverty and thus improve the health and wellbeing of people living in Wales.

ABSTRACTObjectivesAn accurate picture of infant mortality informs society of its social progress. It is a key indicator of how effective public health policies and programs are in caring for the most vulnerable in our society. Currently, at the population level, Victorian data on Aboriginal and Torres Strait Islander births and deaths are excluded from Australian vital statistics. The Victorian Aboriginal Mortality Study aimed to provide a more complete and accurate population profile of Aboriginal births in Victoria using population data linkage of Victorian statutory and administrative datasets. ApproachTwo population statutory datasets, the Victorian Perinatal Data Collection (VPDC) and Victorian Registry of Births, Deaths and Marriages (RBDM) were linked, using probabilistic matching with mother's name and surname, child's date of birth and sex, for all births that occurred in Victoria between 1988 and 2008, inclusive to more accurately ascertain births to mothers and fathers who identified as Aboriginal and/or Torres Strait Islander (hereafter respectfully 'Aboriginal').ResultsOver 1.34 million files, reporting births between 1988 and 2008, were linked. However, due to data integrity issues for Indigenous identification prior to 1998, the years between 1999 and 2008 only were used in the development of the birth cohort. Matching the VPDC with the RBDM resulted in identifying an additional 4,333 live births where mother and/or father identified as Aboriginal, representing an 87% increase in the number of births previously recorded as Aboriginal by the VPDC*. The largest increase (186%) in the number of births where mother and/or father identified as Aboriginal births was observed within the Victorian metropolitan areas. ConclusionThis is the first time that the VPDC and RBDM birth data were linked in Victoria. The matched birth information established a more complete population profile of Aboriginal and/or Torres Strait Islander births. These data will provide a more accurate baseline to enhance the Victorian and Australian governments' ability to plan services, allocate resources and evaluate funded activities aimed at eliminating disparity experienced by Aboriginal and/or Torres Strait Islander peoples. Importantly, it has established a more accurate denominator from which to calculate Aboriginal infant mortality rates for Victoria, Australia.
*Until 2009, the mother's Indigenous identification only was recorded in the VPDC

ABSTRACT
ObjectivesThere is increased interest in identifying strategies the reduce health inequities. With this focus, population health scientists have applied equity measures first developed in other disciplines to health equity research. The objective of this study is to illustrate the application of these measures in research using linkable administrative databases. This presentation will provide a brief description of some commonly-used equity measures and issues investigators face when applying them in their own health equity research.
MethodsAnalyses focused on children born in Manitoba, 1984 to 2014. We used linkable administrative data from health, social services, and education to develop indicators of health and the social determinants of health. Income data from the Canadian Census were used to stratify children by socioeconomic status. Our study considered the distribution of several child outcomes: breastfeeding initiation, mortality, complete immunization rates at age 2, Grade 9 completion, and high school completion. We examined several measures often used to capture income-related health inequities: rate ratios and rate differences comparing children from high-income neighbourhoods with children from low-income neighbourhoods; the concentration index which quantifies the equity in the distribution of outcomes across the entire socioeconomic gradient; and the relative and absolute indices of inequality which compare the most advantaged individuals with the least advantaged individuals in the population while accounting for the distribution of health across the population.
ResultsWhen these measures are applied to health equity, they can be affected by factors not initially considered by investigators. The application of Concentration measures using health outcomes that are frequently dichotomized, and the prevalence of the health outcome can affect the degree of inequity that is possible, with highly prevalent outcomes showing very little divergence from the line of equity. Comparing concentration measures to the inequality indices can produce contradictory and seemingly incompatible results. Sample selection that alters the distribution of income from the population can also change the apparent equity of health outcomes. These matters are complicated when monitoring changes in health equity, over time.
ConclusionsSummary measures of equity can be useful but come with limitations that need to be considered when interpreting and applying study findings. We offer some suggestions to consider when applying these measures in health equity research.